Mortain Place Care Home

People’s experience of using this service and what we found

Risk management needed improvement to ensure peoples’ health and well-being was protected and promoted. We identified shortfalls in respect of the management of specific health problems. For example, management of weight loss, and diabetes. Staff had not had the necessary training to meet people’s individual needs including catheter care. Some aspects of medicine management needed to be improved to ensure people’s safety.

The governance of the service had not supported the service to consistently improve and sustain safe care delivery. Audit systems and processes, whilst in place, had failed to identify risks to people's safety and other aspects of the service that required improvement. There was a lack of clear and accurate records regarding some people's care and support. For example, diabetes and support with hydration. Communication handover sheets were not informative and not used effectively to inform staff. They were missing vital points for staff to follow up on, such as food and fluids to be encouraged, and people being unwell. Changes to people’s health and well- being were therefore not always planned for and monitored effectively.

We received positive feedback from relatives about the quality of care provided to people living at Mortain Place. Relatives told us they felt staff were kind and caring.

People received care and support from staff who had been appropriately recruited and trained to recognise signs of abuse or risk and understood what to do to safely support people. People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible.

There were COVID-19 policies in place for visiting that was in line with government guidance. Families told us that they were welcomed into the home and followed the guidance currently in place.

Referrals were made appropriately to outside agencies when required. For example, GPs, community nurses and speech and language therapists (SALT). Notifications had been completed to inform CQC and other outside organisations when events occurred.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Good (published 03 August 2021).

Why we inspected

We received concerns in relation to staffing, risk management and care delivery. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mortain Place Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service and what we found

The providers’ governance systems had identified some of the shortfalls found at this inspection. we found there was a lack of clear and accurate records regarding changes to people’s health and well -being, for example oral care. Changes to people’s health and well- being were therefore not always planned for and monitored effectively.

People received safe care and support from staff who had been appropriately recruited, trained to recognise signs of abuse or risk, and understood what to do to safely support people. People said, “I feel safe, good food,” and “I like it here genuinely, I’m very safe, I feel this is my home now.” People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. Medicines were given safely to people by competent and knowledgeable staff, who had received appropriate training. There were enough staff to meet people's needs. The provider used a dependency tool to determine staffing levels. Staffing levels were reviewed following falls or changes in a person's health condition. Staff were deployed in a planned way, with the correct training, skills and experience to meet people’s needs.

Visitors were welcomed at the home. People were able to receive visits from their named visitors. Visiting could take place in a lounge which had been converted to a visiting room with a room divider. Dependant on people’s needs, some visits took place in the person’s room. Garden visits were also available. Throughout the pandemic, where people were receiving support with end of life care, they had been able to receive regular visits from family in their bedrooms. Visiting was on an appointment system to allow time for appropriate cleaning between visits and keep the home safe from the risk of infection. All visitors were required to have a rapid Covid-19 test before the visit. During the visit they wore the appropriate personal protective equipment (PPE).

Staff told us that they had received the training they needed to meet people’s needs safely and effectively. The training matrix tracked staff training and this had ensured all staff received the training and updates needed to provide safe consistent care. A plan of supervision to support staff was available and this also included competency sessions on training received. One staff member said, “Supervision is every couple of months, but we are encouraged to speak up if we need support.” People’s nutritional and health needs were consistently met with involvement from health and social care professionals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Everyone we spoke to was consistent in their views that staff were kind, caring and supportive. People were relaxed and comfortable in the company of staff and were treated with respect. People’s independence was considered important by all staff and their privacy and dignity was also promoted.

People were encouraged to go out and meet family and friends. Technology was used to keep families in contact by skype and email. Staff knew people’s communication needs well and staff communicated with people in an effective way.

Care delivery was based on people's preferences and wishes. People were involved in their care planning as much as they could be. One person said, “I am very involved in my care plan because I know what I want.” End of life care planning and documentation guided staff in providing care at this important stage of people’s lives.

People, their relatives and health care professionals had the opportunity to share their views about the service. Complaints made by people or their relatives were taken seriously and thoroughly investigated. One visitor said, “I speak to the manager if I have any concerns.” The provider and manager were committed to continuously improve, and had developed structures and plans to develop and consistently drive improvement within the service to deliver sustainable good care.

Notifications had been completed to inform CQC and other outside organisations when events occurred.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

This service was registered on the 27th September 2019 and this is the first inspection.

Why we inspected:

This was a planned inspection to rate the service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.